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Comparative Outcomes of Robotic Versus Open Proctectomy for Rectal Cancer at High Risk of Positive Circumferential
Stefano Cardelli1, Luca Stocchi1, Amit Merchea1
1Division of Colon and Rectal Surgery, Mayo Clinic Florida, Jacksonville, Florida.
Diseases of the Colon and Rectum
|August 6, 2024
Summary
Robotic proctectomy is an effective alternative to open proctectomy for locally advanced rectal cancer patients at high risk for positive margins. This study found robotic surgery was associated with fewer positive margins, offering a viable option when technically feasible.
Area of Science:
- Oncology
- Surgical Oncology
- Rectal Cancer Treatment
Background:
- Persistent concerns exist regarding the effectiveness of robotic proctectomy versus open proctectomy for locally advanced rectal cancer (LARC) with high risk of positive circumferential resection margin (CRM).
Purpose of the Study:
- To compare surrogate cancer outcomes after robotic versus open proctectomy in LARC patients at high risk for CRM involvement.
Main Methods:
- Retrospective cohort study including 413 patients from three academic hospitals.
- Patients were selected based on MRI-defined high risk for CRM involvement (MERCURY I and II criteria).
- Primary outcome measures included pathologic CRM involvement (≤1 mm), mesorectal grading, and distal margin involvement.
Main Results:
- Robotic proctectomy (70%) was associated with significantly less pathologic CRM involvement (7.3% vs. 17.6%, p=0.002) compared to open proctectomy (30%).
- This association persisted after adjusting for cT stage, neoadjuvant therapy, and multivisceral resection (OR 0.326).
- However, propensity score matching and multivariable analysis did not show a significant difference in CRM positive rates between the two surgical approaches (p=0.86 and p=0.18).
Conclusions:
- Robotic proctectomy is an effective approach for LARC patients at high risk for CRM involvement.
- It can be considered a viable alternative to open proctectomy when technically feasible.
- The study's retrospective design is a limitation.
